Esophageal Motility Changes Following Endoscopic Variceal Band Ligation in Cirrhotic Patients with Esophageal Varices: A Prospective High-Resolution Manometry Study Using Chicago Classification v4.0

Awan Verma, Saurabh Singhal, Abhishek Yadav

Abstract: Endoscopic variceal band ligation (EVBL) is the standard endoscopic treatment for esophageal varices in cirrhosis, but its effect on esophageal motility, when assessed using high-resolution manometry (HRM) and interpreted by the Chicago Classification version 4.0 (CCv4.0), remains poorly characterised. We aimed to evaluate esophageal motility changes before and after EVBL in cirrhotic patients with esophageal varices. In this prospective observational study conducted at a tertiary care centre in northern India, 26 consecutive cirrhotic patients with grade 2-3 esophageal varices scheduled for EVBL underwent HRM before the procedure and again 4-6 weeks afterward. Lower esophageal sphincter (LES) and upper esophageal sphincter (UES) pressures, integrated relaxation pressure (IRP), and esophageal body motility parameters were compared using paired t-tests or Wilcoxon signed-rank tests as appropriate. Categorical HRM diagnoses were compared using McNemar's test. Subgroup analysis was performed by Child-Pugh class, and correlation between the number of bands applied and change in IRP (ΔIRP) was assessed using Pearson and Spearman coefficients. Mean LES basal pressure rose from 30.13 ± 8.12 to 39.53 ± 9.53 mmHg (Δ +9.40 mmHg; p<0.0001), median IRP increased from 12.82 ± 4.16 to 21.70 ± 4.84 mmHg (Δ +8.88 mmHg; p<0.0001), and UES basal pressure increased from 82.82 ± 14.51 to 102.00 ± 28.83 mmHg (Δ +19.18 mmHg; p=0.0002). Esophagogastric junction outflow obstruction (EGJOO) on HRM was newly identified in 88.5% of patients post-EVBL, compared with 11.5% pre-EVBL (McNemar p<0.0001), with no patient reverting from EGJOO to a normal pattern. Esophageal body motility parameters (failed, ineffective, and intact swallow percentages; premature contractions; panesophageal pressurisation) did not differ significantly between the two time points. The rise in IRP was statistically significant across all Child-Pugh classes (A, B, and C) but was numerically attenuated in Class C. The number of bands applied did not correlate with the magnitude of ΔIRP (Pearson r=0.04, p=0.86). EVBL is not motility-neutral: it produces a substantial, consistent, and largely focal rise in esophagogastric junction resistance detectable by HRM, meeting manometric criteria for EGJOO in most patients, while esophageal body peristalsis remains preserved. These findings, obtained using contemporary Chicago Classification v4.0 criteria, provide a measurable physiological explanation for post-EVBL dysphagia and chest pain, and support consideration of HRM in symptomatic patients after variceal band ligation.

Keywords: esophageal variceal band ligation, high-resolution manometry, Chicago Classification, esophagogastric junction outflow obstruction, liver cirrhosis, portal hypertension

How to Cite?: Awan Verma, Saurabh Singhal, Abhishek Yadav, "Esophageal Motility Changes Following Endoscopic Variceal Band Ligation in Cirrhotic Patients with Esophageal Varices: A Prospective High-Resolution Manometry Study Using Chicago Classification v4.0", Volume 15 Issue 7, July 2026, International Journal of Science and Research (IJSR), Pages: 2012-2017, https://www.ijsr.net/getabstract.php?paperid=MR26722123847, DOI: https://dx.doi.org/10.21275/MR26722123847

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